I'm no doctor, but this was so interesting to me. And in the event any PCOS patient is out shopping for BCP, you may want to bring this stuff up with your doc by name and voice any concerns.
IME, I do best on monophasic. Triphasic pills make me feel crazy with the shifting hormone dose. My PCOS already bops around and I need stability, not more bopping around. "Tri" is usually in the name somewhere but not always. (Ex: OrthoCyclen vs Orthotricyclen)
Summarized from Hormonal Balance
book by Scott Isaacs and Neil Shulman
pg 178 - 181
"Synthetic progesterone, called progestin, is not exactly like real progesterone. Progestins stimulate both the progesterone receptor and the androgen receptor and are said to have androgenic activity. When it comes to PCOS I recommend birth control pills that have progestins like drospirenone, desogestrel, or norgestimate. These progestins have the least amount of androgenic activity. The best progestin, drospirenone actually blocks the androgen receptor. It was developed specifically for women with androgen excess. Drospirenone is found in the product Yasmin, which is the most frequently prescribed pill for PCOS. It has a chemical structure similar to the androgen blocking medication spironolactone. It also has mild diurectic properties, so there's less fluid retention and bloating than with other OCPs. Yasmin can also raise potatssium levels which can improve insulin resistance. A side effect can be that potassium levels are too high, so regular blood tests are necessary. Because Yasmin and spironolactone have similar actions, it is inadvisable to take both of these medications at the same time."
"Natural progesterone and the progestins desogestrel, norgestimate, and drospirenone are less androgenic and cause less insulin resistance. Desogestrel, norgestimate, and drospirenone are available only as combination tablets with estrogen.
Desirable Birth Control Pills for PCOS
Natural Progesterone Products
BCP Medications that Contain Desogestrel
- Prometrium (micronized capsules)
- Crinone (gel)
- Prochieve (gel)
- Progestasert (IUD)
Medication That Contain Norgestimate (BCP unless indicated)
- Ortho-tri-cyclen Lo
- Prefest (hormone replacement therapy)
The progestins levongestrel, norgestrel, and norethindrone have high androgenic activity.
For reasons still not understood, syntethic progestins and to a lesser extent, natural progesterone increase insulin resistance and raise blood sugars levels. Synthetic progestins have a more potent effect on insuline sensitivity and have been known to cause diabetes in many cases. Most women who take progestins for long periods of time experience weight gain in the belly. Increased belly fat worsens insulin resistance, raises blood sugars, and increases risk of developing diabetes. "
"The progestins medroxyprogesterone, levongestrel, norgestrel, and norethindrone are the worst in terms of the effects of excess androgen, insulin resistance, and weight gain. "
- Nor QD
- Estrostep Fe
- Plan B
- Climara Pro Patch